Efficacy of Cardiopulmonary Support System and Radiofrequency Catheter Ablation as Life-saving Therapy in a Patient With VT Storm

Abstract

Ventricular tachycardia (VT) storm developed in a 28-year-old woman. The ventricular arrhythmia was refractory to amiodarone infusion and repeated cardioversion. Electrocardiogram showed that the VT cuold be arising from the right ventricular outflow tract (RVOT) and the cycle length was 210ms. She presented with cardiovascular collapse due to tachycardia induced cardiomyopathy and subsequent cardiac arrest. Intra aortic balloon pump (IABP) and percutaneous cardiopulmonary support (PCPS) were inserted as an emergency assist system. Since left ventricular ejection fraction (LVEF) was improved from 20 to 45% on the 5th hospital day, and PCPS and IABP were removed on the 6th and 7th hospital day, respectively. However, despite that amiodarone infusion was continued, repetitive VTs persisted more than 30 sec. Successful radiofrequency catheter ablation, targeting to incessant Vts, was undergone at mid-anterior septum of RVOT, where pace-mapping was best and earliest activation was acquired before the onset of QRS complex. LVEF recovered from 45 to 65% on the 14th hospital day, and her clinical states improved markedly. The patient was free from VT recurrences and impairment of cardiac pump function for more than 12 months. This report is rare case of a successful outcome in a patient with cardiovascular collapse due to VT storm.